Lacosamide

Lacosamide is indicated for the treatment of partial-onset seizures in patients 4 years of age and older.

As the safety of Lacosamide injection has not been established in pediatric patients, Lacosamide injection is indicated for the treatment of partial-onset seizures only in adult patients (17 years of age and older).

It is proposed that lacosamide's inhibition of sodium channels is responsible for analgesia. Lacosamide may be selective for inhibiting depolarized neurons rather than neurons with normal resting potentials. Pain and nociceptor hyperexcitability are associated with neural membrane depolarization. Lacosamide binds to collapsin response mediator protein-2 (CRMP-2), a phosphoprotein which is expressed primarily in the nervous system and is involved in neuronal differentiation and control of axonal outgrowth. The role CRMP-2 of binding in seizure control is hasn't been elucidated.

Adults (17 years and older): Initial dosage for monotherapy is 100 mg twice daily; initial dosage for adjunctive therapy is 50 mg twice daily; maximum recommended dosage for monotherapy and adjunctive therapy is 200 mg twice daily 

Pediatric Patients 4 Years to less than 17 years: The recommended dosage is based on body weight and is administered orally twice daily. Increase dosage based on clinical response and tolerability, no more frequently than once per week

Injection: for intravenous and adult use only when oral administration is temporarily not feasible; dosing regimen is the same as oral regimen; administer over 15 to 60 minutes; obtaining ECG before initiation is recommended in certain patients

Strong CYP3A4 or CYP2C9 Inhibitors: Patients with renal or hepatic impairment who are taking strong inhibitors of CYP3A4 and CYP2C9 may have a significant increase in exposure to Lacosamide. Dose reduction may be necessary in these patients.

Concomitant Medications that Prolong PR Interval: Lacosamide should be used with caution in patients on concomitant medications that prolong PR interval, because of a risk of AV block or bradycardia, e.g., beta-blockers and calcium channel blockers. In such patients, obtaining an ECG before beginning Lacosamide, and after Lacosamide is titrated to steady-state, is recommended. In addition, these patients should be closely monitored if they are administered Lacosamide through the intravenous route.

None

Adjunctive therapy: Most common adverse reactions in adults (≥10% and greater than placebo) are diplopia, headache, dizziness, nausea

Monotherapy: Most common adverse reactions are similar to those seen in adjunctive therapy studies

Pediatric patients: Adverse reactions are similar to those seen in adult patients.

Pregnancy: Based on animal data, may cause fetal harm

Monitor patients for suicidal behavior and ideation

Lacosamide may cause dizziness and ataxia

Cardiac Rhythm and Conduction Abnormalities: Obtaining ECG before beginning and after titration to steady-state maintenance is recommended in patients with known cardiac conduction problems, taking drugs known to induce PR interval prolongation, or with severe cardiac disease; closely monitor these patients

Lacosamide may cause syncope

Lacosamide should be gradually withdrawn to minimize the potential of increased seizure frequency

Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS)/Multi-Organ Hypersensitivity: Discontinue if no alternate etiology.

Atypical anti-depressant drugs.

Dose adjustment is recommended for severe renal impairment. Dose adjustment is recommended for mild or moderate hepatic impairment; use in patients with severe hepatic impairment is not recommended.

Store at 20°C to 25°C